Antibiotic Prophylaxis Maxillofacial Surgery in Adults (216)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Recommendations

Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention.

If >1.5L blood loss, replace fluid and repeat antibiotic dose: co-amoxiclav, metronidazole. Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour.

If surgery >4hrs repeat co-amoxiclav; >8hrs repeat metronidazole. In prolonged surgery repeat co-amoxiclav 1.2g 4 hourly to a maximum of 4 intra-op doses. No repeat dosing of teicoplanin if surgery prolonged.

MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and use penicillin allergy antibiotic prophylaxis option.

CPE carriers: if identified as Carbapenamase producing Enterobacteriaceae carriers contact microbiology

Give Teicoplanin by slow intravenous injection over 3-5 minutes.

Weight based dosing

Consider increasing the dose of the following antibiotics as below:

 

Weight >80 Kg

Weight >160 Kg

Metronidazole

1000 mg

1500 mg

 

Weight > 100 Kg

Co-amoxiclav

Add 1 g IV amoxicillin to 1.2 g Co-amoxiclav

Table: Procedures > Antibiotic

Procedure

Recommended antibiotic

Comments

Procedure expected to last for

< 4 hours (Major 1)

Head & neck Contaminated/clean-contaminated

Or

Clean, malignant; neck dissection

IV Co-amoxiclav 1.2g

or in true penicillin allergy

IV Teicoplanin 800mg*

+

IV Metronidazole 500mg

* Give IV Teicoplanin 400 mg if

Weight ≤ 40 Kg

Prolonged procedure expected to last for > 4 hours (Major 2)

Head & neck contaminated/clean-contaminated

Or

clean, malignant; neck dissection

IV Co-amoxiclav 1.2g repeated 4hrly to maximum 4 intra-op doses

or in true penicillin allergy

IV Teicoplanin 800mg*

+

IV Metronidazole 500mg

Open reduction & internal fixation of compound mandibular fractures

Intraoral bone grafting

Orthognathic surgery

Facial plastic surgery with implant

IV Co-amoxiclav 1.2g

or in true penicillin allergy

IV Teicoplanin 800mg*

+

IV Metronidazole 500mg

Facial Surgery (clean)

Antibiotic prophylaxis not recommended

Head & neck (clean, benign)

Not recommended

Last reviewed: 19 August 2021

Next review: 31 August 2024

Author(s): Ysobel Gourlay

Version: 7

Author Email(s): ysobel.gourlay

Approved By: Antimicrobial Utilisation Committee

Document Id: 216